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Equitable Vaccine Administration Information Submission Template

IC 247457 under ICR 202402-1660-004 · OMB 1660-0017.

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Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

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Equitable Vaccine Administration Information Submission Template
 
No Modified
 
Required to Obtain or Retain Benefits
 
44 CFR 206

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction FEMA Template 104-FY-21-100 Equitable Vaccine Response and Recovery: Vaccine Administration Information FEMA Template FT-104-FY-21-100_Equitable COVID-19 RR Job Aid_Final.docx https://www.fema.gov/sites/default/files/documents/fema_public-assistance-covid-19-medical-care-v2-with-equity-job-aid_policy_3-15-2021.pdf Yes Yes Fillable Printable

Disaster Management Disaster Repair and Restore

DHS/FEMA-009-Hazard Mitigation, Disaster Public Assistance, and Disaster Loan Programs System of Records  79 FR 16015

60 0
   
State, Local, and Tribal Governments
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 13,680 0 0 0 0 13,680
Annual IC Time Burden (Hours) 6,840 0 0 0 0 6,840
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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